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Ahmad Dbouk and Samuel Lazaroff


  • Many monitored pts do not have a true indication

    • Leads to alarm fatigue, unnecessary workups, and is expensive
  • Telemetry is not a substitute for more frequent vital signs

  • Discuss frequently on rounds: always reassess need and indication

  • Stable patients without troponin elevation or new arrythmias are typically appropriate for transfers without telemetry

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Clinical Scenario Duration
Cardiac Cardiac
ACS Post-MI 24-48h 48h after revascularization
Vasospastic angina Until symptoms resolve
Any event requiring ICD shocks Remainder of hospitalization
New/unstable atrial tachyarrhythmias Until stable on medical therapies
Chronic AF w/ recurrence of RVR Clinical judgement
Ventricular tachyarrhythmias Until definitive therapy
Symptomatic bradycardia Until definitive therapy
Decompensated CHF Until underlying cause treated
Procedural Procedural
Ablation (regardless of co-morbidities) 12-24h after procedure
Cardiac surgery 48-72h, or until discharge if high risk for decompensation
Non-cardiac major surgery in patient with AF risk factors Until discharge from step-down or ICU
Conscious sedation Until patient awake, alert, HDS
Miscellaneous Miscellaneous
Endocarditis Until clinically stable
CVA 24-48h
Electrolyte derangement (K, Mg) Until normalization
Hemodialysis Clinical judgement
Drug overdose Until free of influence of substance

Notable non-indications:

  • PCI for non-ACS indication (i.e. pre-transplant), non-cardiac chest pain, Pt with AICD admitted for non-cardiac cause, non-cardiac surgery, chronic AF and clinically stable
  • Contraindicated in hospice/comfort care
  • Nearly all noncardiac conditions (i.e., undifferentiated sepsis, stable GI bleed, alcohol withdrawal) upon transfer out of ICU

Last update: 2022-06-21 14:41:42